To determine whether an intravitreal injection of triamcinolone acetonide for persistent diabetic macular edema after adequate laser treatment improves visual acuity. Prospective, double masked, placebo controlled, randomized clinical t rial. Sixty nine eyes of 43 patients were entered into the study, with 34 eyes randomized to receive active treatment and 35 randomized to receive a placebo in jection. Sixty five of 69 eyes (94%) completed the 3 month study visit. Using a 27 gauge needle, 0.1 ml of triamcinolone acetonide was injected through the pars plana. The procedure was performed in a minor procedures area in the outpat ient clinic under sterile conditions and using topical and subconjunctival anest hesia. Eyes randomized to placebo received a subconjunctival saline injection us ing the identical procedure for preparation. The main outcome measures were impr ovement of best corrected logarithm of the minimum angle of resolution visual a cuity by 5 or more letters and incidence of moderate or severe adverse events. E ighteen of 33 eyes (55%) treated with triamcinolone gained 5 or more letters of best corrected visual acuity compared with 5 of 32 eyes (16%) treated with pl acebo (P=0.002). Macular edema was reduced by 1 or more grades as determined by masked semiquantitative contact lens examination in 25 of 33 treated eyes (75%) versus 5 of 32 untreated eyes (16%; P < 0.0001). Optical coherence tomography showed a mean reduction of central retinal thickness of 152 μm in the 21 treate d eyes that were examined compared with a reduction of 36 μm in 20 placebo tre ated eyes. Infectious endophthalmitis developed in 1 triamcinolone treated eye that was treated adequately without loss of visual acuity. In the short term, in travitreal triamcinolone is an effective and relatively safe treatment for eyes with diabetic macular edema that have failed laser treatment. Although it will b e essential to study longer term outcomes, the use of intravitreal triamcinolon e may be considered in 1 eye of patients who continue to lose vision from diabet ic macular edema despite conventional management.
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